Aims: Bioprosthetic valve thrombosis (BPVT) is an under-recognised cause of prosthetic valve dysfunction and may mimic prosthetic valve endocarditis. This case highlights the diagnostic value of integrating multimodality imaging with clinical, microbiological, and therapeutic findings. Presentation of Case: A 63-year-old woman with a 33-mm MOSAIC® mitral bioprosthesis implanted six years earlier was admitted after two episodes of fever. Transthoracic echocardiography showed an increase in the mean transmitral gradient from 7.4 mmHg before admission to 12 mmHg, with leaflet thickening and reduced mobility. Transoesophageal echocardiography demonstrated adherent echogenic material but could not reliably differentiate thrombus from vegetation. ^18F-FDG PET/CT showed intense diffuse circumferential uptake around the mitral bioprosthesis (SUVmax 7.2), initially raising suspicion of prosthetic valve endocarditis. However, repeated blood cultures remained negative and the inflammatory syndrome resolved spontaneously without antibiotic therapy. ECG-gated cardiac CT demonstrated circumferential leaflet thickening with hypoattenuating lesions (<90 HU), strongly supporting bioprosthetic valve thrombosis. Anticoagulation resulted in progressive haemodynamic improvement, with the mean transmitral gradient decreasing to 8 mmHg and subsequently to 6 mmHg. Discussion: This case illustrates the potential for BPVT to mimic prosthetic valve endocarditis, including increased ^18F-FDG uptake. PET/CT findings should therefore be interpreted in conjunction with clinical, microbiological, echocardiographic, and anatomical imaging data. Conclusion: In cases of discordant findings, multimodality imaging, particularly cardiac CT, can be decisive in distinguishing bioprosthetic valve thrombosis from infective endocarditis and guiding appropriate therapy.
Functional mitral stenosis may occur when transmitral flow is impaired in the absence of intrinsic mitral valve disease. We report a case of apparent mitral stenosis associated with severe aortic regurgitation and postoperative resolution after aortic valve replacement. A 54-year-old man with hypertension presented with persistent palpitations and New York Heart Association class III dyspnoea. Electrocardiography showed atrial fibrillation with a mean ventricular rate of 120 beats/min. Transthoracic echocardiography demonstrated severe eccentric aortic regurgitation directed towards the anterior mitral leaflet, with a vena contracta of 6.6 mm, pressure half-time of 210 ms, effective regurgitant orifice area of 34 mm², and regurgitant volume of 70 mL. The anterior mitral leaflet showed fluttering and reduced diastolic opening, with an interleaflet distance of 11 mm, mitral valve area of 1.6 cm² by planimetry, and a mean transmitral pressure gradient of 18 mmHg, despite the presence of thin, morphologically normal mitral leaflets. After heart rate control and multidisciplinary assessment, the patient underwent surgical aortic valve replacement with a mechanical prosthesis. Three weeks after surgery, echocardiography showed normal prosthetic valve function, disappearance of mitral leaflet fluttering, an increase in the intervalvular distance to 26 mm, and normalisation of the mean transmitral pressure gradient to 1.5 mmHg. This case supports the diagnosis of reversible functional mitral stenosis caused by haemodynamic interaction between severe aortic regurgitation and mitral valve motion.
Background: Acute pulmonary embolism (PE) is a major cardiovascular emergency associated with substantial morbidity and mortality, particularly when diagnosis is delayed. Because the clinical spectrum varies widely (mild dyspnea to near-cardiac collapse), it is important for clinicians to classify patients according to risk shortly after diagnosis so that they may use that classification to determine the level of treatment intensity and monitoring needed. There is very little information available about northern Africa tertiary cardiac care centers. The aim of this study was to describe the clinical characteristics, risk classification (based on the ESC guidelines), treatment patterns and short-term outcomes of patients with acute PE who were hospitalized in the Cardiology Department of Ibn Rochd University Hospital in Casablanca. Methods: A retrospective observational study was conducted to review and analyze the data of all consecutively hospitalized patients diagnosed with acute PE between January 2024 and December 2025 (a 2-year study period). Recorded demographic data, clinical presentation and treatment, as well as risk classification and in-hospital outcomes were collected through chart review. Patients were classified according to the latest ESC guidelines for risk classification dated 2019. Results: Twenty-two men and thirty-two women were included (n = 54); women accounted for 59.3% of the cohort. Mean age was 60 ± 18 years (range, 22–88 years). The most common predisposing factors were prolonged immobilization (81%), obesity (52%), recent surgery (28%), hormonal or postpartum exposure (28%), active cancer (15%), and previous venous thromboembolism (7%). High-risk PE was observed in 17% of patients, while intermediate-high-risk PE accounted for 44%. In addition, 39% of study patients were classified as intermediate-low risk. No patient in this study was classified as a low-risk patient. Anticoagulation was the first-line treatment for acute pulmonary embolism (acute PE), with 30% of patients taking direct oral anticoagulants, 30% receiving subcutaneous low-molecular-weight heparin, followed by oral vitamin K antagonists, 25% receiving intravenous unfractionated heparin followed by oral vitamin K antagonists, and 15% receiving subcutaneous low-molecular-weight heparin only. Five (9%) of the patients received systemic thrombolysis. The mean length of hospital stay was 7 ± 3 days; 87% required ICU admission during hospitalization. The in-hospital mortality rate was 9 out of 54 (16.7%). The high-risk group had 55.6% mortality (5 out of 9) and the intermediate-high-risk group had a 16.7% mortality (4 out of 24). In our cohort, most of the acute PE cases occurred in terms of early risk (intermediate/high early risks); included a transient provoking factor (patients had multiple factors that might cause them to experience acute PE) and were often obese. The large amount of in-hospital mortality associated with acute PE emphasizes the importance of early severity assessment, initiation of anticoagulation, appropriate escalation of treatment, and developing an organized written follow-up system after hospital discharge.
Severe aortic stenosis in frail older adults requiring urgent hip fracture surgery represents a major therapeutic challenge. Delaying orthopaedic repair may worsen outcomes, whereas proceeding directly to surgery in the setting of critical aortic stenosis carries substantial perioperative risk. We report the case of an 89-year-old frail woman living in a nursing home, with Alzheimer’s disease, hypertension, osteoporosis, and known severe calcific aortic stenosis, who was admitted for a left pertrochanteric hip fracture after a ground-level fall. Transthoracic echocardiography confirmed severe aortic stenosis with a peak velocity of 4.8 m/s, a mean gradient of 63 mmHg, and an indexed aortic valve area of 0.42 cm²/m², with preserved left ventricular ejection fraction. Because immediate orthopaedic surgery was considered to carry prohibitive anesthetic risk, a multidisciplinary team selected balloon aortic valvuloplasty as a bridge strategy. The procedure reduced the peak-to-peak transvalvular gradient from 75 to 20 mmHg, and post-procedural echocardiography showed a mean gradient of 26 mmHg with preserved ventricular function. Gamma nail fixation was successfully performed under general anesthesia the following day. This case highlights that balloon aortic valvuloplasty may serve as a pragmatic short-term bridge to urgent hip fracture repair in carefully selected frail patients with severe aortic stenosis who are poor candidates for immediate definitive valve intervention. Decisions should remain individualized and based on a multidisciplinary Heart Team assessment.
Background: Acute pulmonary embolism (PE) constitutes a leading cause of illness and death from cardiovascular disease around the world. Even with better ways to diagnose and treat PE, it is still difficult to manage, especially in places where local data are limited. In Morocco, there is little recent hospital-based information about the clinical characteristics of patients admitted with acute PE. Aim: This study aims to describe the epidemiology, risk factors, clinical presentation, and diagnostic features of patients with acute PE admitted to the cardiology department at Ibn Rochd University Hospital. Methods: A retrospective descriptive study of consecutive patients admitted to the cardiology department of Ibn Rochd University Hospital, Casablanca, conducted for acute PE confirmed by CTPA between January 2024 and December 2025. Demographic characteristics, thromboembolic risk factors, clinical presentation, electrocardiographic findings, echocardiographic features, and CTPA findings were extracted from medical records and analysed descriptively. Results: Fifty-four patients were included, with a mean age of 60 ± 18 years (range 22–88); 58% were women. At least one provoking or contributing factor was found in 98% of patients. Prolonged immobilisation was the most common risk factor, present in 81% of cases. Obesity, recent surgery, hormonal exposure or postpartum status among women, active cancer, chronic heart disease or chronic respiratory disease, history of miscarriage by females, prior history of venous thromboembolism, were all reported to be risk factors for pulmonary embolism. The most common presenting symptom was dyspnea, followed by chest pain (98%), and ECG changes were frequently observed (S1Q3 pattern [50%], anterior T-wave inversions [44%], and sinus tachycardia [37%]). A right ventricular dilation was observed in 65% of participants via an echocardiogram, systolic dysfunction was also seen in 48% of patients, and all cases were confirmed on a CTPA. Proximal emboli were noted in 72% of patients and 69% of patients demonstrated bilateral involvement. Conclusion: In this single-centre Moroccan study, acute PE occurred mainly in middle-aged and older adults and was slightly more common in women. Identifiable thromboembolic risk factors were frequent, especially immobilisation, obesity, surgery, cancer, and hormonal exposure. CTPA was the basis of diagnosis, while echocardiography provided important information on right ventricular involvement. The results show the need for better prevention, earlier diagnosis, and larger multicenter studies on pulmonary embolism in Morocco.
Background: Cardiovascular disease accounts for approximately 45% of all-cause mortality in hemodialysis patients — a risk 10 to 20 times higher than in the general population. Despite the critical role of echocardiography in characterizing this cardiac burden, systematic echocardiographic data from local dialysis centers remain scarce. Objectives: The study aims to provide a comprehensive echocardiographic characterization of end-stage of chronic kidney disease (CKD) patients on maintenance hemodialysis. We assessed left ventricular (LV) geometry, systolic function, diastolic function, and the prevalence and severity of valvular disease. Methods : Single-center cross-sectional study of 78 consecutive adults with end stage renal disease (ESRD) on maintenance hemodialysis (≥ 3 months) at the Echocardiography Department of University Hospital Mohamed VI, Marrakesh, from May 2024 to May 2025. All examinations followed the 2015 ASE/EACVI chamber quantification guidelines. Diastolic function was formally graded in 49 patients in sinus rhythm without significant mitral disease, using the 2016 ASE/EACVI four-variable algorithm. Results : Mean age 56.3 ± 12.8 years; 59.0% male. LV hypertrophy was found in 74.4%, predominantly concentric (56.4%). Only 7 patients (9.0%) had completely normal LV geometry. Reduced LV ejection fraction (EF < 50%) was present in 30.8%, with severely reduced EF (< 35%) in 12.8%. Among 49 formally evaluable patients, diastolic dysfunction was identified in 77.6%: Grade I in 32.7%, Grade II in 28.6%, Grade III in 16.3%. valvular abnormalities were found in 61.5%; moderate-to-severe aortic stenosis in 7.7%; moderate-to-severe mitral regurgitation in 15.4%; and non-rheumatic mitral stenosis in 6.4%. Elevated estimated pulmonary artery systolic pressure (> 35 mmHg) was present in 43.6%. Conclusions : End-stage CKD patients on hemodialysis carry a severe, multidimensional cardiac burden. These findings support the implementation of routine, protocol-driven echocardiographic evaluation at dialysis initiation and at regular intervals thereafter.
Background: Iron deficiency is a common comorbidity in patients with heart failure. This association is often underrecognized in clinical practice, despite its important implications for symptoms and prognosis. Iron deficiency has been associated with worse symptoms, impaired functional status, and poorer clinical outcomes. Data from North Africa remain scarce, particularly in older adults hospitalized for acute or decompensated heart failure Methods: A single-center (Ibn Rochd University Hospital in Casablanca) prospective observational study was conducted in the Cardiology Division. The study included consecutive patients aged ≥65 years admitted for acute heart failure, including both de novo presentations and acute decompensation of previously known chronic heart failure during a 12-month period. Iron deficiency was defined as a ferritin concentration <100 ng/mL, or 100-299 ng/mL with transferrin saturation <20%. Clinical, laboratory, and echocardiographic data were collected at admission. Patients were followed for one year for a composite outcome of heart failure rehospitalization or all-cause death. Results: Fifty patients were included; the median age was 84 years (range, 65-104). Men and women were equally represented. Hypertension was present in 82%, diabetes in 32%, and active smoking in 18%. Functional limitation was substantial, with 50% of patients in NYHA class II, 40% in class III, and 10% in class IV. Anemia occurred in 52% of this cohort, and among those with Anemia, 82% of those were iron deficient. Among patients with iron deficiency, 63% were anemic and 37% were not. Echocardiographic findings displayed LVEF <45% for 38%; LV end-diastolic diameter >55 mm 24%; TAPSE <16 mm 24%; elevated pulmonary artery systolic pressure 40%; and a PASP/TAPSE ratio >3 mmHg/mm of 30%. At one year, event-free survival for the composite endpoint of heart failure rehospitalization or all-cause death was 94%. Given the very low number of events observed during follow-up, subgroup comparisons were descriptive and should be interpreted cautiously. Conclusions: In this cohort of Moroccan patients hospitalized for acute heart failure, iron deficiency was highly prevalent and was frequently present in the absence of overt anemia. The data has highlighted the need for routine iron testing during the inpatient stay; as this will allow for the identification of patients who may later qualify for intravenous iron therapies after they have undergone a period of medical stabilization.
Background: Papillary muscle rupture (PMR) is a rare but rapidly fatal mechanical complication of acute myocardial infarction (MI) that may occur even after apparently limited ischemia. In the contemporary reperfusion era, its incidence is estimated between 0.05% and 0.26% of MIs, yet mortality remains extremely high. Case Summary: A 67-year-old woman with diabetes presented with isolated acute dyspnea and subtle ST-segment elevation in inferior and posterior leads. Transthoracic echocardiography (TTE) revealed inferior wall akinesia and acute severe mitral regurgitation (MR) caused by flail mitral leaflet motion secondary to subtotal rupture of the posteromedial papillary muscle (PMPM). Within hours of admission, she developed sudden neurological deficits consistent with hyperacute ischemic stroke, followed by massive pulmonary edema and refractory cardiogenic shock (CS). Despite intensive supportive management and planned urgent surgical intervention, the patient died before surgery could be performed. Discussion: PMR remains one of the most devastating mechanical complications of MI, with mortality reaching up to 80% without surgical treatment. This case highlights the importance of recognizing atypical presentations of myocardial infarction, particularly in diabetic patients presenting without chest pain. The case is valuable for the scientific and clinical community as it emphasizes the need for early echocardiographic evaluation and rapid multidisciplinary management. Furthermore, the combination of PMR and acute ischemic stroke represents an uncommon and educational clinical scenario.
Background: Acute aortic regurgitation is an uncommon but life-threatening complication of infective endocarditis. It results from rapid destruction of the aortic valve or extension of infection to surrounding structures, leading to abrupt hemodynamic deterioration that often requires urgent surgical intervention. Case presentation: We report two cases of fulminant acute aortic regurgitation complicating infective endocarditis. The first patient, a 58-year-old woman, presented with Staphylococcus haemolyticus infection associated with extensive destruction of the aortic cusps and torrential regurgitation. The second patient, a 46-year-old woman, developed severe acute aortic regurgitation due to infective endocarditis complicated by a mitro-aortic trigone abscess and cusp prolapse. In both cases, transesophageal echocardiography was essential in identifying the severity of valvular damage and establishing the indication for urgent surgery. Despite appropriate antibiotic therapy and intensive medical care, both patients experienced rapid clinical deterioration and died before surgical intervention could be performed. Conclusion: These cases highlight the fulminant course and poor prognosis of acute aortic regurgitation complicating infective endocarditis. Early echocardiographic diagnosis and immediate surgical referral are crucial to improve patient outcomes.
Background: Infective endocarditis (IE) associated with implantable cardiac devices (ICDs): pacemakers, automatic defibrillators, and cardiac resynchronisation therapy devices, is a rare but serious complication with a high mortality rate despite therapeutic advances. The steady increase in the number of implantations worldwide is accompanied by a parallel rise in infection cases, even exceeding the expected growth in the implantation rate. Aim: The objective of this study was to describe the epidemiological, clinical, microbiological, therapeutic, and prognostic characteristics of IE associated with ICDs in a Moroccan university hospital in Marrakech. Materials and Methods: We conducted a retrospective descriptive study in the cardiac electrophysiology department of the university hospital Mohammed VI in Marrakech, covering the period from January 2022 to December 2025. All patients hospitalised for infective endocarditis associated with a pacemaker or implantable cardioverter-defibrillator, meeting the modified Duke criteria, were included. Epidemiological, clinical, paraclinical, therapeutic, and outcome data were collected from medical records and hospitalisation registers and then analysed using an Excel spreadsheet. Results: Of the 200 patients who underwent endocarditis implantable cardioverter-defibrillator (ECID) implantation in our department during the study period, 19 patients (9.5%) developed a device-related infection, including 16 implanted at our centre and 3 outside the hospital. The mean age of infected patients was 66 years (range 45–80 years), with a marked male predominance (male-to-female ratio 2:1). The most frequently observed cardiovascular risk factors were hypertension (7 patients), diabetes (4 patients), dyslipidemia (3 patients), and chronic smoking (5 patients). The time between implantation and the onset of endocarditis was less than three months in 8 patients (early infection) and more than three months in the remaining 11 (late infection). Local signs of infection (erythema, warmth, fluctuation, swelling, or skin dehiscence) were present in 63% of patients, while fever was absent in 77% of cases. Blood cultures were positive in 12 patients (58.3%), with a clear predominance of staphylococci: coagulase-negative Staphylococcus (6 cases), methicillin-resistant Staphylococcus aureus (3 cases), and, less frequently, Klebsiella pneumoniae, Pseudomonas, and Streptococcus sobrius. Transesophageal echocardiography revealed vegetations in only 10% of patients, highlighting the diagnostic difficulty of this condition. All patients received initial empirical antibiotic therapy with amoxicillin-clavulanic acid and gentamicin due to the local unavailability of antibiotics recommended by learned societies. This was followed by tailored antibiotic therapy: dual therapy (flucloxacillin plus gentamicin) in 15 patients (70%) and triple therapy (vancomycin, rifampicin, and gentamicin) in 4 patients (20%). Infected material was removed by simple mechanical traction in 10 patients and by excimer laser in the remaining 9, with temporary stimulation via the right jugular vein in 9 patients awaiting reimplantation. Contralateral definitive reimplantation was performed in 17 patients after negative blood cultures. The outcome was favourable in 83% of cases (15 patients), while two patients died from refractory septic and cardiogenic shock. Conclusion: Infective endocarditis associated with implantable cardiac devices primarily affects middle-aged men, often diabetic, and typically presents with local symptoms without fever. Diagnosis relies on blood cultures and transesophageal echocardiography. Complete removal of the material, preferably by laser, combined with prolonged antibiotic therapy, is the standard treatment. Prevention depends on strict aseptic technique during implantation.
Background: Heart failure with reduced ejection fraction (HFrEF) is a leading cause of cardiovascular mortality and morbidity worldwide. Optimized pharmacological therapy — comprising the four pillars of neurohormonal blockade (ACE inhibitors/ARBs, beta-blockers, MRA, SGLT2i) — has substantially reduced mortality and morbidity. The primary therapeutic goal in HFrEF is to improve survival, reduce hospitalizations, and enhance quality of life through guideline-directed medical therapy (GDMT). Adherence to guidelines varies internationally, particularly in low- and middle-income countries. Objectives: To evaluate prescribing patterns and adherence to ESC guidelines for HFrEF management at the Avicenne Military Hospital, Marrakech, and compare with international benchmarks. Methods: Retrospective observational study of 173 HFrEF patients (LVEF <40%) hospitalized between December 2021 and December 2023. Inclusion criteria: adults aged ≥18 years with echocardiographically confirmed HFrEF. Exclusion criteria: patients with incomplete medical records or those transferred before completion of diagnostic workup. Diagnosis was confirmed by transthoracic echocardiography, clinical assessment, and BNP/NT-proBNP levels. Comorbidities including hypertension, diabetes mellitus, atrial fibrillation, chronic kidney disease, and ischemic heart disease were systematically recorded. Prescription rates for each drug class and interventional procedures were extracted. Results: Beta-blockers were prescribed in 87%, mineralocorticoid receptor antagonists (MRA) in 78%, ACE inhibitors in 74%, SGLT2 inhibitors in 33%, and sacubitril/valsartan in 8%. Percutaneous coronary intervention (PCI) was performed in 33%, coronary bypass surgery in 11%. Device therapies (CRT, ICD) were markedly underutilized (2 and 1 patients, respectively). Conclusion: Pharmacological management at this center aligns broadly with ESC guidelines, with notably good beta-blocker and MRA uptake. However, SGLT2i and sacubitril/valsartan prescribing remains below guideline targets, and device therapy is markedly underutilized, reflecting resource constraints and access issues in the Moroccan context.
Cholesterol is a key risk factor that can be altered and has become a primary factor in cardiovascular disease. Still, trend analyses at the global level often use aggregated estimates as error-free, which may exaggerate accuracy. The objective of the study was to measure long-term trends in the means of total cholesterol across countries and had the advantage of clearly modelling demographic structure, in addition to accounting for measurement error. The aims were to analyse changes over time by sex and age group, to examine nonlinear dynamics in age-period models, and to compare conventional and uncertainty-aware modelling. Multidecade-long country-year-sex-age group data on harmonised data used multilevel growth models, generalised additive mixed models and uncertainty-aware weighted multilevel models in which inverse-variance weights were based on reported 95% uncertainty intervals. Findings revealed that the average total cholesterol decreased significantly worldwide (weighted annual change: -0.0027 mmol/L, p = 0.046), with women having higher baseline levels than men (\(\beta\) = 0.09 mmol/L difference, p < 0.001). The temporal declines were steeper in older age, but the interaction between years and test age ranged from -0.0008 mmol/L/year to -0.0084 mmol/L/year (p < 0.001). Uncertainty-aware estimates were consistently smaller than those from unweighted models, indicating less overconfidence. The nonlinear age-period interaction was significant (p < 0.001). Its novelty lies in propagating reported uncertainty intervals directly into hierarchical models, which is the primary statistical constraint in previous studies. Among the actionable recommendations, it is possible to mention implementing models of uncertainty-aware global surveillance and focusing on age- and sex-specific approaches to lipid control to achieve faster progress toward cardiovascular disease reduction goals.
Background: The etiological distribution of heart failure with reduced ejection fraction (HFrEF) varies significantly across regions, reflecting differences in cardiovascular risk factor prevalence, genetic predisposition, and healthcare access. Data from North African military populations are scarce. This study aimed to characterize the etiological spectrum of HFrEF in a Moroccan military hospital and compare findings with major international registries. Methods: This was a retrospective observational registry study conducted at the Avicenne Military Hospital, Marrakech, Morocco, over a two-year period (2021–2023). Etiologies were systematically classified in 173 consecutive HFrEF patients (left ventricular ejection fraction <40%) based on clinical history, electrocardiographic findings, echocardiographic pattern, and coronary angiographic results. Descriptive statistics were used, with results expressed as frequencies and percentages for categorical variables and means ± standard deviations for continuous variables. Results: A total of 173 patients were included (mean age 67.9 ± 8.7 years; 80% male). The dominant cardiovascular risk factors were sedentary lifestyle (85%), smoking (53%), diabetes mellitus (45%), hypertension (33%), and dyslipidemia (33%). Ischemic cardiomyopathy was the predominant etiology (56.6%), followed by idiopathic dilated cardiomyopathy (17.3%), hypertensive cardiomyopathy (11.6%), arrhythmia-induced cardiomyopathy (6.4%), valvular cardiomyopathy (5.8%), and toxic cardiomyopathy (1.7%). Coronary angiography was performed in 118 patients (68.2%), with multivessel disease as the most frequent finding: tritroncoronary involvement in 22%, bitroncoronary in 14%, and single-vessel significant disease in 19%. The left anterior descending artery was the most commonly affected vessel (41%). Compared to international registries, the ischemic etiology burden exceeded that of the Asian JCARE-CARD registry (34.0%) and the African INTER-CHF cohort (13.0%), and aligned with the ESC HF Long-Term Registry (48.6%) and the SwedeHF registry (60.0%). Conclusion: Ischemic cardiomyopathy dominates the etiological spectrum of HFrEF in this Moroccan military cohort, reinforcing the priority of coronary risk factor management and timely coronary revascularization in prevention strategies. Future multicenter prospective studies across North Africa and expanded access to cardiac MRI are recommended.
Background: Hypertension often clusters with other cardiometabolic risk factors, increasing overall cardiovascular risk, especially in Nigeria. Understanding this pattern is essential for improving comprehensive and effective management. Aims: To determine the prevalence of individual cardiometabolic risk factors and their clustering patterns, and to identify factors associated with high metabolic burden in a hypertensive cohort attending a tertiary centre in South-South Nigeria. Study Design: Retrospective hospital-based cross-sectional study. Place and Duration of Study: Medical Outpatient Clinic (MOPC), University of Benin Teaching Hospital (UBTH), Benin City, Edo State, Nigeria. Methodology: Medical records of 826 adult hypertensive patients attending a tertiary centre in South-South Nigeria were reviewed in this retrospective hospital-based cross-sectional study. Bivariate associations were assessed using Chi-square tests, and binary logistic regression identified independent predictors of high metabolic burden, defined as hypertension co-occurring with two or more additional cardiometabolic abnormalities from a defined set of three (dysglycaemia, hypertriglyceridaemia, or low HDL-C). Results: The mean age was 54.93 ± 16.18 years; 56.9% were female and 74.2% were married. Any dyslipidaemia was present in 553 participants (66.9%). Metabolic burden distribution: 443 (53.6%) had hypertension only, 309 (37.4%) had one additional abnormality, and 74 (9.0%) had high metabolic burden. The most common comorbid phenotype was HTN with low HDL-C (19.9%), followed by HTN with dysglycaemia (14.3%). Sex (P = .007), marital status (P = .001), age group (P < .001), blood glucose category (P < .001), and proteinuria severity (P < .001) were significantly associated with high metabolic burden. On logistic regression, male sex (AOR 0.387; 95% CI 0.220–0.681), higher eGFR (AOR 1.013; 95% CI 1.004–1.021), and proteinuria (AOR 2.894; 95% CI 1.757–4.765) were independent predictors; age was not a significant independent predictor after adjustment. Conclusion: Cardiometabolic clustering affects a notable proportion of hypertensive patients at a Nigerian tertiary centre. Male sex, eGFR, and proteinuria independently predict high metabolic burden, underscoring the need for integrated metabolic and renal screening within hypertension management programmes in sub-Saharan Africa.
Background: Cardiac involvement significantly impacts the prognosis of sarcoidosis. While conduction abnormalities represent the classic presentation, inaugural acute heart failure with severe left ventricular dysfunction is a less common and diagnostically challenging phenotype that can closely mimic idiopathic dilated cardiomyopathy. Furthermore, diagnosing cardiac sarcoidosis (CS) can be complex when initial advanced imaging yields false-negative results. Case Presentation: A 43-year-old female with a history of cutaneous sarcoidosis, maintained on chronic oral corticosteroids, presented with rapidly progressive heart failure (New York Heart Association class III). Transthoracic echocardiography revealed severe left ventricular systolic dysfunction with an ejection fraction of 26%. Her clinical course was notably complicated by an episode of paroxysmal atrial fibrillation and a subsequent transient ischemic attack (TIA). Cardiac magnetic resonance (CMR) imaging was non-contributory, showing no evidence of edema or late gadolinium enhancement. However, due to high clinical suspicion, an 18F-FDG PET/CT was performed, revealing intense, multifocal myocardial uptake indicative of active granulomatous inflammation. Recognising the corticosteroid-refractory nature of her flare-up, she was treated with intravenous corticosteroid pulses, followed by the early introduction of methotrexate as a steroid-sparing agent, optimised guideline-directed medical therapy (GDMT) for heart failure, and therapeutic anticoagulation with apixaban. At one year, the patient was completely asymptomatic with a full normalisation of her ejection fraction to 52%. Conclusion: This case highlights that a normal CMR does not exclude active cardiac sarcoidosis, especially in the early inflammatory stages, reinforcing the critical diagnostic value of 18F-FDG PET/CT. Additionally, it demonstrates that severe, corticosteroid-refractory ventricular dysfunction can achieve complete functional reversibility through the early and synergistic use of methotrexate and GDMT.
Background: Vitamin K antagonist (VKA)-induced skin necrosis is a rare but life-threatening complication, typically occurring during the initiation phase of anticoagulation therapy. Its disseminated presentation is exceptional and poses a major diagnostic and therapeutic challenge. Despite its rarity, mortality rates remain high, particularly when complicated by secondary infection and multi-organ failure. The coexistence of leukocytoclastic vasculitis on biopsy adds further complexity to an already difficult clinical picture. Case Presentation: We report the case of a 46-year-old woman with known moderate mitral stenosis in sinus rhythm, who developed extensive necrotic skin lesions involving the upper and lower limbs, face, and trunk, fifteen days after initiation of acenocoumarol therapy for a new-onset episode of atrial fibrillation. Laboratory findings revealed a supratherapeutic INR of 6.12, associated cardiac decompensation, severe inflammatory syndrome, and acute kidney injury. Protein C and Protein S deficiency were excluded. Despite intensive care management, the patient rapidly progressed to septic shock secondary to Pseudomonas aeruginosa superinfection. Skin biopsy unexpectedly revealed leukocytoclastic vasculitis, raising a complex differential diagnosis. Discussion: This case illustrates the diagnostic complexity surrounding severe VKA-induced skin reactions. The clinical timeline strongly suggested coumarin-induced thrombotic necrosis; however, histological evidence of leukocytoclastic vasculitis introduced the possibility of drug-induced vasculitis or septic purpura as contributing or alternative etiologies. The absence of heparin bridging at the time of VKA initiation likely represents the pivotal preventable factor in this fatal outcome. Conclusion: This exceptional case underscores the importance of rigorous INR monitoring during VKA initiation, the necessity of systematic heparin bridging, and the need to consider multiple competing diagnoses when facing severe cutaneous complications of anticoagulation therapy. Early skin biopsy and prompt dermatological assessment are essential to guide management in such cases.
Cardiac autonomic neuropathy (CAN) is a frequent yet underdiagnosed complication of diabetes mellitus, associated with increased cardiovascular morbidity and mortality. Orthostatic hypotension (OH) is its most common manifestation and may coexist with supine hypertension (SH), creating a therapeutic dilemma. We report the case of a 62-year-old Moroccan woman with long-standing type 2 diabetes mellitus who presented with dizziness and exertional intolerance. Blood pressure measurements revealed supine hypertension (160/90 mmHg) and orthostatic hypotension (110/70 mmHg upon standing), associated with symptoms. Autonomic testing confirmed cardiac autonomic neuropathy after exclusion of secondary causes. A tailored therapeutic approach combining non-pharmacological measures and nocturnal transdermal nitrates led to significant clinical improvement within one week, with better blood pressure stability. The coexistence of OH and SH in CAN represents a complex clinical entity requiring individualized management and early recognition to improve outcomes.
Introduction: Sarcomeric hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease. Its prognosis is primarily determined by the risk of ventricular arrhythmias and sudden cardiac death (SCD). This study aimed to describe the rhythm profile of patients with sarcomeric HCM, to identify clinical and paraclinical predictors of arrhythmias, and to assess the risk of SCD using the European Society of Cardiology (ESC) risk stratification score. Materials and Methods: This retrospective descriptive study included 30 patients with sarcomeric HCM followed in an electrophysiology department between July 2021 and December 2025. All included patients underwent a complete clinical examination, a surface electrocardiogram (ECG), a 24- to 48-hour Holter ECG recording, a transthoracic echocardiogram, and, for 20 of them, cardiac magnetic resonance (CMR) imaging. The 5-year risk of SCD was calculated using the ESC online risk score. Results: The mean age of the patients was 46 ± 29 years, with a male-to-female ratio of 2.7. Atrial fibrillation (AF) was the most frequent arrhythmia, affecting 20% of patients (16% of whom presented with a paroxysmal form). Premature ventricular contractions (PVCs) were observed in 90% of patients on Holter monitoring, while only one patient (3.3%) presented with non-sustained ventricular tachycardia (NSVT). Regarding the SCD risk score, 73% of patients were classified as low risk (<4%), 10% as intermediate risk (4–6%), and 17% as high risk (≥6%). Five patients underwent implantable cardioverter-defibrillator (ICD) implantation for primary prevention. Notably, no thromboembolic complications or deaths were recorded during the 4-year follow-up period. Conclusion: In our series, atrial fibrillation was the most frequent arrhythmia in patients with sarcomeric HCM. The ESC 2014 score proved to be an effective tool for stratifying the risk of SCD. ICD implantation in high-risk patients was well tolerated and may improve prognosis.
Background: Heart failure with reduced ejection fraction (HFrEF) represents a growing global public health burden, particularly in low- and middle-income countries where cardiovascular risk factors are prevalent and undercontrolled. Data from North Africa and Morocco remain scarce. Objectives: To describe the epidemiological profile and cardiovascular risk factor distribution of HFrEF patients hospitalized at a military tertiary center in Marrakech, Morocco. Methods: Retrospective descriptive study conducted between December 2021 and December 2023, including 173 adult patients hospitalized for HFrEF (LVEF ≤ 40%) at the Cardiology Department of Avicenne Military Hospital. Data were extracted from medical records and analyzed using Microsoft Excel 2019. Results: The mean age was 67.9 ± 8.7 years (range 38–92), with a strong male predominance (80%). The most prevalent cardiovascular risk factors were sedentary lifestyle (85%), smoking (53%), type 2 diabetes (45%), hypertension (33%), and dyslipidemia (33%). Associated comorbidities included anemia (45%), renal failure (36%), and prior ischemic cardiomyopathy (41.6%). These findings align broadly with international registries while highlighting specificities of the North African context. Conclusion: HFrEF in Morocco predominantly affects elderly males with multiple modifiable cardiovascular risk factors. This profile underscores the urgent need for comprehensive primary prevention strategies and improved management of hypertension, diabetes, and smoking in the region.
Background: Recent guidelines emphasize the pathophysiological continuum of acute coronary syndromes (ACS). However, the real-world clinical presentation of ST-segment elevation myocardial infarction (STEMI) compared to non-ST-segment elevation myocardial infarction (NSTEMI) differs considerably. Aim: The objective of this study is to compare the clinical characteristics, metabolic profiles, and angiographic severity between patients admitted for STEMI and those admitted for NSTEMI. Methods: This was a single-center, observational, and analytical study conducted over a 6-month period at the Cardiology Department of the Mohammed VI University Hospital (CHU Mohammed VI) in Marrakesh, Morocco. Following written informed consent, it included 144 consecutive adult patients admitted for ACS who underwent diagnostic coronary angiography, strictly excluding those managed with an exclusively conservative strategy. Clinical data, metabolic profiles, and angiographic findings were systematically extracted and compared. Results: The study included 97 STEMI patients (67.4%) and 47 NSTEMI patients (32.6%). The overall mean age was 63.7 ± 10.1 years. The NSTEMI group had a significantly higher proportion of females (55.3% vs. 26.8% in the STEMI group, p = 0.002) and hypertensive patients (61.7% vs. 27.8%, p < 0.001). Active smoking was predominant in the STEMI group (49.5% vs. 25.5%, p = 0.011). The metabolic burden was substantial and similar across both groups, particularly for diabetes (53.2% NSTEMI vs. 51.5% STEMI) and dyslipidemia (44.7% NSTEMI vs. 47.4% STEMI). Angiographically, STEMI was predominantly associated with single-vessel disease (56.7%) involving the left anterior descending artery (LAD, 63.9%). Conversely, NSTEMI involved the left circumflex artery (LCx) significantly more often (23.4% vs. 10.3%, p = 0.001) and was more frequently associated with severe triple-vessel disease (21.3% vs. 10.3%, p = 0.179). Conclusion: This study confirms a profound dimorphism in the real-world presentation of ACS that often diverges from classic guideline paradigms. While STEMI predominantly characterizes younger, smoking males with single-vessel LAD occlusion, NSTEMI frequently involves older, hypertensive females presenting with complex, diffuse, and sometimes angiographically occlusive multivessel disease. Recognizing these real-world discrepancies is crucial for avoiding treatment delays and optimising individualised management.
